Clinica di Malattie dell'Apparato Respiratorio, Ospedale San Paolo, Università degli Studi di, 20142 Milano, Italy.
Pulm Pharmacol Ther. 2010 Jun;23(3):159-64. doi: 10.1016/j.pupt.2010.01.004. Epub 2010 Jan 22.
Some studies suggest that the sympathetic nervous system and the renin-angiotensin system are activated in patients with chronic obstructive pulmonary disease (COPD), potentially resulting in negative cardiopulmonary and muscular effects. The aim of this pilot study was to evaluate the efficacy of an angiotensin converting enzyme (ACE) inhibitor on cardiopulmonary exercise performance in COPD patients. Primary outcome was the effect of treatment on the ventilatory response to exercise (VE/VCO(2) slope). Secondary outcomes were exercise variables evaluated by the cardiopulmonary exercise test, and pulmonary function according to ACE genotyping.
4 weeks treatment with enalapril (10 mg od) or placebo was evaluated in 21 COPD patients (FEV(1) < 60%) and without cardiovascular disease in a double-blind, cross-over study.
18 patients completed the study. Enalapril did not exert a significant effect on exercise VE/VCO(2) slope or on peak O(2) consumption. However enalapril significantly improved peak O(2) pulse and work rate compared to placebo. A mild but significant worsening of the diffusion capacity of the lung was observed. ACE genotype did not significantly affect patients' response to treatment, except for a trend toward a more evident effect of treatment in patients with II ACE genotype in terms of O(2) pulse and gas diffusion.
In this pilot study, ACE inhibition did not affect the ventilatory response to exercise in COPD patients. However, treatment resulted in improvement in work rate and O(2) pulse, suggesting that ACE inhibitor therapy warrants consideration and may provide beneficial effect on the cardiovascular response to exercise in COPD.
一些研究表明，慢性阻塞性肺疾病（COPD）患者的交感神经系统和肾素-血管紧张素系统被激活，可能导致心肺和肌肉的负面效应。本初步研究旨在评估血管紧张素转换酶（ACE）抑制剂对 COPD 患者心肺运动能力的疗效。主要结局是治疗对运动时通气反应（VE/VCO2 斜率）的影响。次要结局是心肺运动试验评估的运动变量，以及根据 ACE 基因分型评估的肺功能。
在一项双盲交叉研究中，21 例 COPD 患者（FEV1<60%）且无心血管疾病，接受了 4 周依那普利（10mg 每日一次）或安慰剂治疗。
18 例患者完成了研究。依那普利对运动时 VE/VCO2 斜率或峰值 O2 消耗没有显著影响。然而，与安慰剂相比，依那普利显著提高了峰值 O2 脉搏和做功率。肺弥散能力出现轻微但显著恶化。ACE 基因型并未显著影响患者对治疗的反应，但在 ACE 基因型 II 的患者中，治疗对 O2 脉搏和气体弥散的影响有趋于更明显的趋势。
在这项初步研究中，ACE 抑制对 COPD 患者的运动通气反应没有影响。然而，治疗导致做功率和 O2 脉搏的改善，提示 ACE 抑制剂治疗值得考虑，并可能对 COPD 患者的运动心血管反应产生有益影响。
